evolving markets require evolving market approaches
DESCRIPTION
UNITAID's Brenda Waning Presentation at the UNITAID/UNAIDS/Medicines Patent Pool Side Event, United Nations High Level Meeting on AIDSNew York9 June, 2011TRANSCRIPT
Evolving markets require evolving market approaches
Brenda Waning
UNITAID/UNAIDS/Medicines Patent Pool Side Event
United Nations High Level Meeting on AIDS
New York
9 June, 2011
UNITAID Goal
Healthy markets, healthy people
UNITAID aims to promote “healthy”, dynamic market conditions whereby manufacturers have incentives to invest and innovate, while at the same time supply quality public health products at sustainable, affordable prices and in acceptable formulations that enable the maximum number of people to access them.
How UNITAID intervenes UNITAID’s role depends upon the particular circumstances in a given market:
• Market catalyst: identifying and facilitating adoption and uptake of new and/or superior public health products;
• Market creator: providing incentives for manufacturers to produce otherwise unattractive products with low demand that yield little profit but substantial public health benefit to those in need; and
• Market “fixer”: addressing severe market inefficiencies (e.g. grossly inaccurate demand forecasts and excessive transaction costs) that contribute to low access to quality-assured public health products.
UNITAID Market impact framework
HIV/AIDS & poor access to antiretroviral
(ARV) medicines
Price negotiation, demand creation, pooled purchase,
information sharing, WHO PQ
High ARV prices from low
demand & lack of competition
More people treated with less money; benefits extend beyond
country recipients
Lower ARV prices, more generic
versions, increase in suppliers,
competition & awareness
UNITAID Intervention example: 2nd line ARV market
Pathway from market to public health impactCase for intervention
Public health problem & commodity access issue
Market shortcomings
& their reasons
Innovativemarket
intervention
Sustainable market impact
Public health impact & Value for
money
Lessons learned from the past 10 years (1)
Environment, market characteristics & interventions
• Industrial structures were “simpler”: innovator vs. generic; Innovator revenues derived from high income countries
• Unprecedented influx of HIV/AIDS funding
• Largely donor-driven, donor-controlled market• Policy harmonization & coordination across donors, organizations
• WHO Prequal & FDA created level playing field around quality
• Intellectual property barriers largely absent for most ARVs
Lessons learned from the past 10 years (2)Environment, market characteristics & interventions
• WHO treatment guidelines drove & consolidated demand• 5 ARVs on 2003 WHO guidelines constituted 98% of ARVs purchased 2004-2006*
• WHO treatment guidelines inconsistent with those in the north (treat at later stage w/ different ARVs)
• Information on market prices available in public domain
RESULT: “healthy” competition, price reduction, assured quality, development of new products (FDC, paediatric) appropriate for developing country settings rapid scale-up
*Waning et al. Intervening in Global Markets…Globalization & Health 2010, 6:9.
*Waning et al. A lifeline to treatment…
Journal of the International AIDS Society 2010;13:35
ARV market share bymanufacturer type, 2003-2008*
39%
80%
64%
83%88% 87%
1%
13%
3%3% 8%
61%
19% 23%14%
9% 5%
0%
20%
40%
60%
80%
100%
2003 2004 2005 2006 2007 2008
Ma
rke
t S
ha
re (
vo
lum
e)
Indian Generic Non-Indian Generic Brand
Overview of ARV market evolution
82% 86%
16%
6%6%
12% 8%
84%
0%
20%
40%
60%
80%
100%
Pediatric Adult NRTI/NNRTI Adult PI
Ma
rke
t S
ha
re (
vo
lum
e)
Indian Generic Non-Indian Generic Brand
2008 ARV market shareby niche &manufacturer type*
Future challenges for tomorrow’s market (1)
Environment, market characteristics & interventions
•Industrial structures more complicated: • Largest revenue growth is in middle-income pharmerging markets• Innovators producing generics & acquiring generic firms• Indian generic firms moving upstream to R&D, biotech• Renewed national interest in local production: collision of economic, industrial development, and public health policies
• Flat-line donor budgets for HIV in the wake of financial crisis
• National governments purchasing more ARVs• New market anchors/powers like South Africa (25% global market) - disaggregated power & market; countries becoming big players• Quality standards no longer harmonized (national vs. global)
Future challenges for tomorrow’s market (2)
Environment, market characteristics & interventions
• WHO HIV/AIDS treatment guidelines becoming more consistent with those in the north• Treat earlier with better but more expensive ARVs
• Treatment as prevention may push treatment even earlier• Use of CD4, viral load and other diagnostics
• Intellectual property barriers for new ARVs• Patents, TRIPS, Free Trade Agreements
RESULT: much more complicated market environment where market interventions used in the past no longer fit. Need to engage new players (innovators, national governments, etc) and develop new approaches to support scale-up
CD4 Product Pipeline*
2009 2010 2011 2012 2013
PointCare
Partec Mini
PIMA
DaktariBurnet
mBio
Zyomyx
Instruments Disposable
*Estimated - timeline and sequence may change; created by Murtagh on behalf of UNITAID 2011
But lots of innovation in HIV diagnostics:
Viral Load & EID Product Pipeline*
2011 2012 2013 2014 2015
Alere
NWGHF VL
NWGHF EID SAMBA EID SAMBA VL
LiatWave 80 EO-
NAT
Gene XPert
Micronics
Biohelix
ALL
*Estimated – timeline and sequence may change; created by Murtagh on behalf of UNITAID 2011
Summary & Conclusions
• Market-based approaches are powerful interventions that support global scale-up of HIV/AIDS treatment
• Success over the past 10 years: price reductions & development of better, quality-assured products
• But the landscape has changed dramatically. Market evolution presents new challenges for the next 10 years
• Need to be forward-thinking, monitoring and anticipating market evolution
•Need new market approaches from donors, international organizations, national governments, generic and innovator manufacturers, NGOs and others to achieve universal access
Thank you
Contact Information:
Brenda Waning
Coordinator, Market Dynamics
UNITAID
Email: [email protected]